PALS version A
You are caring for a child who was resuscitated after a drowning event. The child is intubated and
ventilated with 100% oxygen with equal breath sounds and exhaled CO2 detected. The heart rate is
slow and the monitor shows sinus bradycardia. The skin is cool, mottled, and moist; distal pulses are
not palpable and the central pulses are weak. Intravenous access has been established. The core
temperature is 37.3oC. Based on the PALS bradycardia algorithm, which of the following should be
provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion
Correct Answers: Epinephrine IV
You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate = 220/min). The
child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not palpable.
Which of the following would be the best treatment to provide without delay?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg
Correct Answers: Provide synchronized cardioversion at 0.5 to 1 J/kg
You are initiating treatment for a child with septic shock and hypotension. While administering high-
flow oxygen you determine that the child's respirations are adequate and SpO2 is 100%. You have
just established vascular access and obtained blood samples. Which of the following is the next most
appropriate therapy to support systemic perfusion?
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion
Correct Answers: Administer repeated fluid boluses of isotonic crystalloid
You are treating an 8-year-old with ventricular tachycardia with pulses and adequate perfusion. You
attempted synchronized cardioversion without success. While seeking expert consultation, it would
be most appropriate to:
Administer a loading dose of milrinone
Consider possible metabolic and toxicological causes
Initiate overdrive pacing transcutaneous
Deliver an unsynchronized shock
, Correct Answers: Consider possible metabolic and toxicological causes
You are caring for a 2-year-old unconscious patient who is intubated and receiving mechanical
ventilation. The child's heart rate suddenly drops to 40/min and his color becomes mottled. You
should respond to these changes by:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen
Correct Answers: Using a resuscitation bag provide manual ventilation with 100% oxygen
You are caring for a 9-month-old patient with pronounced respiratory distress. You initiated high-flow
oxygen using a no rebreathing mask about 10 minutes ago and established intravenous access.
Initially the infant's heart rate was in the 150/min range with strong pulses. Suddenly the infant's
respiratory rate falls to 6/min with significant intercostal retractions, and little air movement is heard.
The infant becomes cyanotic and the heart rate decreases to 95/min. Which of the following
treatments would be best for you to provide now?
Administer epinephrine IV
Provide bag-mask ventilation
Administer magnesium sulfate IV
Intubate and ventilate
Correct Answers: Provide bag-mask ventilation
Which of the following is likely to be the most helpful technique to identify potentially reversible
metabolic and toxic causes during the attempted resuscitation of a young child in cardiac arrest?
Obtaining a urine sample for toxicology screen
Obtaining chest and abdominal radiographs
Soliciting a history from the caregiver or family
Obtaining a venous blood gas
Correct Answers: Soliciting a history from the caregiver or family
You are caring for a patient who developed a tension pneumothorax after several hours of positive-
pressure ventilation. Which of the following would be the most appropriate site for needle
decompression?
Over the third rib at the midclavicular line
Under the eighth rib at the maxillary line
Over the fifth rib at the sternal border
Under the sixth rib at the midclavicular line
Correct Answers: Over the third rib at the midclavicular line
You are caring for a child who was resuscitated after a drowning event. The child is intubated and
ventilated with 100% oxygen with equal breath sounds and exhaled CO2 detected. The heart rate is
slow and the monitor shows sinus bradycardia. The skin is cool, mottled, and moist; distal pulses are
not palpable and the central pulses are weak. Intravenous access has been established. The core
temperature is 37.3oC. Based on the PALS bradycardia algorithm, which of the following should be
provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion
Correct Answers: Epinephrine IV
You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate = 220/min). The
child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not palpable.
Which of the following would be the best treatment to provide without delay?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg
Correct Answers: Provide synchronized cardioversion at 0.5 to 1 J/kg
You are initiating treatment for a child with septic shock and hypotension. While administering high-
flow oxygen you determine that the child's respirations are adequate and SpO2 is 100%. You have
just established vascular access and obtained blood samples. Which of the following is the next most
appropriate therapy to support systemic perfusion?
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion
Correct Answers: Administer repeated fluid boluses of isotonic crystalloid
You are treating an 8-year-old with ventricular tachycardia with pulses and adequate perfusion. You
attempted synchronized cardioversion without success. While seeking expert consultation, it would
be most appropriate to:
Administer a loading dose of milrinone
Consider possible metabolic and toxicological causes
Initiate overdrive pacing transcutaneous
Deliver an unsynchronized shock
, Correct Answers: Consider possible metabolic and toxicological causes
You are caring for a 2-year-old unconscious patient who is intubated and receiving mechanical
ventilation. The child's heart rate suddenly drops to 40/min and his color becomes mottled. You
should respond to these changes by:
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen
Correct Answers: Using a resuscitation bag provide manual ventilation with 100% oxygen
You are caring for a 9-month-old patient with pronounced respiratory distress. You initiated high-flow
oxygen using a no rebreathing mask about 10 minutes ago and established intravenous access.
Initially the infant's heart rate was in the 150/min range with strong pulses. Suddenly the infant's
respiratory rate falls to 6/min with significant intercostal retractions, and little air movement is heard.
The infant becomes cyanotic and the heart rate decreases to 95/min. Which of the following
treatments would be best for you to provide now?
Administer epinephrine IV
Provide bag-mask ventilation
Administer magnesium sulfate IV
Intubate and ventilate
Correct Answers: Provide bag-mask ventilation
Which of the following is likely to be the most helpful technique to identify potentially reversible
metabolic and toxic causes during the attempted resuscitation of a young child in cardiac arrest?
Obtaining a urine sample for toxicology screen
Obtaining chest and abdominal radiographs
Soliciting a history from the caregiver or family
Obtaining a venous blood gas
Correct Answers: Soliciting a history from the caregiver or family
You are caring for a patient who developed a tension pneumothorax after several hours of positive-
pressure ventilation. Which of the following would be the most appropriate site for needle
decompression?
Over the third rib at the midclavicular line
Under the eighth rib at the maxillary line
Over the fifth rib at the sternal border
Under the sixth rib at the midclavicular line
Correct Answers: Over the third rib at the midclavicular line
